Factors Affecting Graft Uptake of Large Wound Surface, Covered by Mesh Split Skin Grafting: A Longitudinal Study

Abstract

Introduction: Skin grafting is one of the most indispensable techniques in surgery these days. In low resource settings, skin grafting using mesh, still forms the important technique of wound coverage. Aim: To evaluate the factors affecting graft uptake of large wound surface, covered by mesh split skin grafting on various postoperative days (day 5, day 10 and day 21). Materials and Methods: This prospective longitudinal study was conducted at Indira Gandhi Government Medical College and Hospital, Nagpur, Maharashtra, India, from June 2017 to December 2019, among patients with large wound surface. After baseline evaluation and wound preparation; patients were posted for mesh skin grafting. Postoperatively, the graft uptake percentage was assessed on the day 5, day 10 and day 21. Other parameters that were assessed were demographic details, mean stay of the patients during the preoperative and postoperative period, effect of various factors (age, gender, co-morbidities, addictions, site and aetiology of raw area, preoperative cultures) influencing graft uptake and postoperative complications. Statistical Package for Social Sciences (SPSS) version 20.0 was used for statistical analysis. Results: A total of 117 patients were enrolled in the study, out of which, 97 (82.9%) of the patients were males. The most common raw area was seen in lower limbs and accounted for 98 patients (79.1%) and the most common cause of raw area was cellulitis (n=91). Out of 117 patients, 105 (89.7%) had successful graft uptake on postoperative day 5, 102 patients (87.2%) on day 10 and 100 patients (85.4%) on day 21. Whereas, 17 (14.5%) patients had failed uptake of graft on postoperative day 21. It was observed that age (p-value=0.04) and preoperative cultures (p-value=0.01) were statistically significant factors influencing graft uptake. Conclusion: The present study reports mesh split skin grafting, a reliable and useful technique with successful graft uptake. Hence, it can be considered for the management of large raw areas.